[ RadSafe ] In utero dose

[Cindy Bloom]

My sense is that ALARA applies to regulated workers' exposures to 
radiation.  For diagnostic and therapeutic medical radiation exposures, the 
key would be optimization of the risks, benefits and costs (I believe there 
is an ICRP publication on optimization).  In emergency-type situations, the 
costs are probably given little thought and the focus is on the benefits of 
obtaining  information (or perhaps reducing swelling, in the case of a 
brain tumor, etc.).  It would make sense if generic planning for 
emergencies considered the risks, benefits and costs.  I would guess 
professional organizations routinely provide guidance on these matters and 
that most radiology programs consider these matters at least informally 
(and would be well advised to consider these issues formally).  As noted by 
others, life-saving, as well as preservation of quality of life (lives), is 
of greatest importance, and in most instances it will be very unlikely that 
the risks of radiation exposure outweigh the benefit of obtaining 
diagnostic information that allows more rapid treatment of the emergency.

I think the balancing of image quality and radiation exposure is more a 
matter of optimization than ALARA, but perhaps the semantics are best left 
for discussion in a casual setting.

Cindy

At 06:13 PM 4/18/2006 -0400, Michael Bohan wrote:
>Hello Floyd and RadSafer's:
>
>In medicine, the conservative approach (of ALARA for radiation) is usually 
>NOT advisable.  ALARA is specifically an industrial hygiene practice that 
>has been bastardized by some to apply to realms it was never intended for.
>
>If there is a pregnant mother, who's been in a serious car accident, the 
>risk of having an undiagnosed condition that results in immediate death to 
>the mother and/or fetus, is real.   The theoretical risk of even a 10 rad 
>dose to her and the fetus are a very small concern in comparison.  Even 
>with a dose of 10 rad, the theoretical risk to the fetus is about 1 in a 
>thousand, and it might only be expressed many years later.  However, the 
>mortality of mothers and fetuses from serious car accidents and 
>undiagnosed trauma, is immediate and probably would lead to 10's if not 
>100's of deaths/thousand, if modern diagnostic tests are withheld due to 
>radiophobia.  It should be remembered that ALARA is meant to keep 
>occupational workers well away from any risk at all, even theoretical 
>ones.  When reality strikes, we need to use a different set of standards.
>
>ALARA does have a place in medicine.  Medical Physicists spend a lot of 
>time and energy making sure that all hospital equipment provides the best 
>diagnostic information for the smallest necessary dose.   However, ALARA 
>should never be used to deny a patient a necessary diagnostic procedure.
>
>Regards,
>
>Mike Bohan, RSO
>Yale-New Haven Hospital
>Radiological Physics
>20 York St. - WWW 204
>New Haven, CT 06510
>Tele: (203) 688-2950
>Fax: (203) 688-8682
>Email: mike.bohan at yale.edu
>
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>On Apr 18, 2006, at 2:32 PM, radsafe-request at radlab.nl wrote:
>
>>I realize this. But taking the conservative approach is always
>>advisable. Hence ALARA. The lack of set limits is an issue which should
>>be addressed. We cannot continue to let the medical world self-police.
>>They have proven time and time again that they are prone to leaning to
>>one extreme or the other. The limit should mirror occupational dose
>>except, of course in the case of limits hindering treatment. All of this
>>falls into the principals of ALARA in one way or another.
>
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